507 results on '"Lawrence S.C. Czer"'
Search Results
152. Not All INTERMACS Level 1’s Are the Same: Survival After Total Artificial Heart Implantation with or without Temporary Circulatory Support
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Danny Ramzy, James Mirocha, Fardad Esmailian, J. Chung, J. D. Moriguchi, Heidi Reich, David Chang, Francisco A. Arabia, Lawrence S.C. Czer, Alfredo Trento, and M. De Robertis
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,law.invention ,law ,Internal medicine ,Artificial heart ,Circulatory system ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
153. Angiogenesis on Coronary Angiography Is a Marker for Accelerated Cardiac Allograft Vasculopathy as Assessed by Intravascular Ultrasound
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Richard Cheng, Jignesh Patel, David Chang, Lawrence S.C. Czer, Jon A. Kobashigawa, Tamar Aintablian, and Babak Azarbal
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Pulmonary and Respiratory Medicine ,Coronary angiography ,Transplantation ,medicine.medical_specialty ,medicine.diagnostic_test ,Angiogenesis ,business.industry ,Cardiac allograft vasculopathy ,Internal medicine ,Intravascular ultrasound ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
154. Pre-Implant Moderate-Severe Fibrosis on Liver Biopsy Predicts Adverse Outcomes After Mechanical Circulatory Support
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Jignesh Patel, Ryan Levine, David Chang, R. Mohan, Michelle M. Kittleson, J. Neyer, J. D. Moriguchi, Francisco A. Arabia, Lawrence S.C. Czer, Jon A. Kobashigawa, and Tamar Aintablian
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Pulmonary and Respiratory Medicine ,Transplantation ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Adverse outcomes ,business.industry ,Severe fibrosis ,Surgery ,Liver biopsy ,Circulatory system ,medicine ,Implant ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
155. The Story on Extracorporeal Membrane Oxygenation (ECMO) Directly to Mechanical Circulatory Support or to Heart Transplantation
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Danny Ramzy, Dael Geft, Michelle M. Kittleson, M. Hashimoto, David Chang, Lawrence S.C. Czer, Jignesh Patel, Jon A. Kobashigawa, Ryan Levine, Tamar Aintablian, and Evan P. Kransdorf
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Circulatory system ,Extracorporeal membrane oxygenation ,Cardiology ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2017
156. Severe Tricuspid Regurgitation After Heart Transplantation: Does It Require Surgical Repair?
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B. Kearney, Dael Geft, Michelle M. Kittleson, Jignesh Patel, Lawrence S.C. Czer, K. Yabuno, David Chang, Jon A. Kobashigawa, Alfredo Trento, Tamar Aintablian, and Evan P. Kransdorf
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Surgical repair ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Regurgitation (circulation) ,Internal medicine ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
157. Survival and Allograft Rejection Rates after Combined Heart and Kidney Transplantation in Comparison with Heart Transplantation Alone
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James Mirocha, Ernst R. Schwarz, M. De Robertis, Alfredo Trento, Stanley C. Jordan, Robert M. Kass, K. Patel, S.P. Gallagher, A. Ruzza, Lawrence S.C. Czer, and R. Vespignani
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Heart disease ,medicine.medical_treatment ,Urology ,Renal function ,Kaplan-Meier Estimate ,Risk Assessment ,Young Adult ,Risk Factors ,medicine ,Humans ,Transplantation, Homologous ,Survival rate ,Kidney transplantation ,Aged ,Heart Failure ,Heart transplantation ,Transplantation ,Chi-Square Distribution ,Ejection fraction ,business.industry ,Patient Selection ,Perioperative ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Los Angeles ,Surgery ,Survival Rate ,Treatment Outcome ,Heart Transplantation ,Kidney Failure, Chronic ,Female ,business - Abstract
The role of solid multiorgan transplantation remains to be determined. We compared our experience with combined heart-kidney transplantation (HKT) and heart transplant alone (HT), and assessed patient survival rates and freedom from allograft rejection in these two patient groups.We reviewed the clinical outcomes of patients undergoing HKT (n=30) or HT (n=440) between June 1992 and March 2009. Baseline patient characteristics, perioperative factors, incidence of rejection, and survival were examined.There were no significant differences between the two groups for age, gender, etiology of heart disease, functional class, preoperative left ventricular ejection fraction, end-diastolic diameter, cardiac output, or transplant waitlist status. Patients with HKT had a higher serum creatinine level (P.001) and a greater incidence of hypertension (P=.04). No differences were found in cardiac allograft ischemic times, including cardiopulmonary bypass or cross-clamp times. Kidney allograft ischemic time was 14.6±9 hours (mean±SD; range, 4 hours to 49 hours). Kaplan-Meier survival estimates were similar for the HKT and HT groups at 30 days (93%±4.6% versus 98%±0.7%), 1 year (87%±6.2% versus 93%±1.2%), 5 years (68%±9.0% versus 76%±2.1%), and 10 years (51%±11% versus 53%±3.0%; P=.54 for all comparisons). Follow-up serum creatinine levels were similar after HKT and HT at 30 days (1.6±1.8 mg/dL versus 1.1±0.4 mg/dL), 1 year (1.4±0.6 mg/dL versus 1.5±0.6 mg/dL), and 5 years (1.8±1.8 mg/dL versus 1.8±1.2 mg/dL; P.05 for all comparisons).HKT offers excellent survival and similar renal function when compared with HT alone. Patients with end-stage cardiac and renal failure can be considered for HKT.
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- 2011
158. Impact of Virtual Cross Match on Waiting Times for Heart Transplantation
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James Mirocha, R. Yanagida, Matthew Rafiei, Kai Cao, Alfredo Trento, Michele A. De Robertis, Lawrence S.C. Czer, Jon A. Kobashigawa, Robert M. Kass, and Nancy L. Reinsmoen
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Adult ,Graft Rejection ,Male ,Pulmonary and Respiratory Medicine ,Waiting time ,medicine.medical_specialty ,Time Factors ,Waiting Lists ,medicine.medical_treatment ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Heart transplantation ,Graft rejection ,Geographic area ,business.industry ,Histocompatibility Testing ,Panel reactive antibody ,Middle Aged ,Surgery ,Antibody mediated rejection ,Heart Transplantation ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Heart transplantation for sensitized patients has been a significant challenge. In this study, outcome of heart transplantation in sensitized patients with virtual cross match was compared with prospective cross match. Methods Prior to July 2007, prospective cross match was used and afterward, virtual cross match with Luminex (One Lambda, Inc, Canoga Park, CA) based antibody analysis was used for potential heart transplant recipients. Prospectively collected data for the 3 years before and after July 2007, in sensitized (panel reactive antibody greater than 10%) and nonsensitized heart transplant recipients were reviewed. Results One hundred sixty-eight patients met inclusion criteria for analysis (78 patients for prospective cross match and 90 patients for virtual cross match). Multiple parameters were compared for the prospective cross match and virtual cross match eras. Three-year survivals in nonsensitized patients were 84.6% and 77.2% and in sensitized patients were 76.9% and 77.4% (p = 0.49) for prospective cross match and virtual cross match eras, respectively. Freedom from 3A (2R) cellular rejection in nonsensitized patients was 96.9% and 95.3%, and in sensitized patients was 90.9% and 100% (p = 0.83). Freedom from antibody-mediated rejection in nonsensitized patients was 95.3% and 96.8%, and in sensitized patients was 90.9% and 90.5% (p = 0.65). Mean waiting time was 129 ± 246 days (mean ± SD) for the period before virtual cross match and 59 ± 78 days with virtual cross match (p = 0.018). Donor geographic area was similar for prospective and virtual cross match. Conclusions In sensitized heart transplant candidates, virtual cross match may shorten waiting time to heart transplantation without increasing subsequent occurrence of cellular rejection, antibody mediated rejection, and mortality after heart transplantation.
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- 2011
159. Heart Transplantation in Patients Aged 70 Years and Older: A Two-Decade Experience
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Ernst R. Schwarz, Matthew Rafiei, Alfredo Trento, M. De Robertis, James Mirocha, Daniel Daneshvar, Anita Phan, Robert M. Kass, Lawrence S.C. Czer, and J.R. Pixton
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Male ,Reoperation ,Aging ,Pediatrics ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Postoperative Hemorrhage ,Risk Assessment ,Renal Dialysis ,Risk Factors ,Intubation, Intratracheal ,Humans ,Medicine ,Intubation ,In patient ,Contraindication ,Survival rate ,Dialysis ,Aged ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Transplantation ,business.industry ,Patient Selection ,Age Factors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Los Angeles ,Survival Rate ,Treatment Outcome ,Heart failure ,Heart Transplantation ,Female ,Surgery ,business - Abstract
Objective Advanced age has been viewed as a contraindication to orthotopic heart transplantation (OHT). We analyzed the outcome of OHT in patients who were aged 70 years or older and compared the results with those in younger patients during a two-decade period. Methods A total of 519 patients underwent first-time single-organ OHT at our institution from 1988 to 2009. Patients were divided into three groups by age: ≥ 70-years old (group 1, n = 37), 60 to 69-years old (group 2, n = 206), and ≤60-years old (group 3, n = 276). Primary endpoints were 30-days, and 1-, 5-, and 10-years survival. Secondary outcomes included re-operation for bleeding, postoperative need for dialysis, and length of postoperative intubation. Results There was no significant difference in survival between the greater than or equal to 70-year-old group and the two younger age groups for the first 10 years after OHT. Survival rates at 30 days, and 1-, 5-, and 10-years, and median survival in group 1 recipients were 100%, 94.6%, 83.2%, 51.7%, and 10.9 years (CI 7.1–11.0), respectively; in group 2 those numbers were 97.6%, 92.7%, 73.8%, 47.7%, and 9.1 years (CI 6.7–10.9), respectively; and in group 3 those numbers were 96.4%, 92.0%, 74.7%, 57.1%, and 12.2 years (CI 10.7–15.4; P = NS), respectively. There was no significant difference in secondary outcomes of re-operation for bleeding, postoperative need for dialysis, and prolonged intubation among the three age groups. Conclusions Patients who are aged 70 years and older can undergo heart transplantation with similar morbidity and mortality when compared with younger recipients. Advanced heart failure patients who are aged 70 years and older should not be excluded from transplant consideration based solely on an age criterion. Stringent patient selection, however, is necessary.
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- 2011
160. Exercise Performance Comparison of Bicaval and Biatrial Orthotopic Heart Transplant Recipients
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Mabelle H. Cohen, J.R. Pixton, M. Awad, Matthew Rafiei, Harmik J. Soukiasian, S.P. Gallagher, Alfredo Trento, Lawrence S.C. Czer, and L.A. Czer
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Regurgitation (circulation) ,Anastomosis ,Coronary artery disease ,Oxygen Consumption ,Internal medicine ,Heart rate ,medicine ,Humans ,Aged ,Retrospective Studies ,Heart Failure ,Body surface area ,Heart transplantation ,Transplantation ,Exercise Tolerance ,Pulmonary Gas Exchange ,business.industry ,VO2 max ,Recovery of Function ,Middle Aged ,medicine.disease ,Los Angeles ,Surgery ,Stenosis ,Treatment Outcome ,Exercise Test ,Cardiology ,Heart Transplantation ,Female ,Pulmonary Ventilation ,business - Abstract
Background The standard biatrial technique for orthotopic heart transplantation uses a large atrial anastomosis to connect the donor and recipient atria. A modified technique involves bicaval and pulmonary venous anastomoses and is believed to preserve the anatomic configuration and physiological function of the atria. Bicaval heart transplantation reduces postoperative valvular regurgitation and is associated with a lower incidence of pacemaker insertion. Objective The aim of this study was to compare postoperative functional capacity and exercise performance in patients with bicaval and biatrial orthotopic heart transplantation. Methods Patients were selected for the study if they did not have any of the following: obstructive coronary artery disease (>50% stenosis), severe mitral or tricuspid regurgitation, signs of rejection (grade ≥1B-1R) on endomyocardial biopsy during the prior year, respiratory impairment, a permanent pacemaker, orthopedic or muscular impediments, or lived more than 150 miles from the medical center. A total of 27 patients qualified. In 15 patients who received a biatrial heart transplant and 12 patients with a bicaval heart transplant, a stationary bicycle exercise test was performed. Ventilatory gas exchange and maximum oxygen consumption measurements were measured. Results Recipient and donor characteristics, including body surface area, donor/recipient weight mismatch, immunosuppressive regimen, and self-reported weekly exercise activity, did not differ between the biatrial and bicaval groups (P = not significant [NS]). At peak exercise, similar heart rate, workload, oxygen consumption, carbon dioxide production, ventilation, functional capacity, and exercise duration were found between the 2 groups (P = NS). Patients in the biatrial group were studied later than patients in the bicaval group (6.54 ± 0.71 vs 4.68 ± 0.28 years; P Conclusion There were no significant differences in the exercise capacity between patients with biatrial versus bicaval techniques for orthotopic heart transplantation. Factors other than the atrial connection (such as cardiac denervation, immunosuppressive drug effect, or physical deconditioning) may be more important determinants of subnormal exercise capacity after heart transplantation. Nevertheless, the reduction in morbidity and postoperative complications and the simplicity in the bicaval technique suggest that bicaval heart transplantation offers advantages when compared with the standard biatrial technique.
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- 2011
161. Successful Combined Heart-Bilateral Lung-Kidney Transplantation From a Same Donor to Treat Severe Hypertrophic Cardiomyopathy With Secondary Pulmonary Hypertension and Renal Failure: Case Report and Review of the Literature
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Jeremy A. Falk, Wen Cheng, George Chaux, Sinan Simsir, A. Peng, R.K. Rana, J.L. Cohen, Sara Ghandehari, Lawrence S.C. Czer, Ernst R. Schwarz, and A.S. Ghaly
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Nephrology ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Cardiomegaly ,Internal medicine ,medicine ,Humans ,Lung transplantation ,Renal replacement therapy ,Kidney transplantation ,Transplantation ,business.industry ,Hypertrophic cardiomyopathy ,medicine.disease ,Kidney Transplantation ,Pulmonary hypertension ,Tissue Donors ,Cardiology ,Heart Transplantation ,Kidney Failure, Chronic ,Surgery ,business ,Lung Transplantation ,Kidney disease - Abstract
This study describes the first reported case of a combined heart-lung-kidney transplantation. Our patient suffered from hypertrophic cardiomyopathy due to long-standing hypertension with Dana Point Classification Group 2 pulmonary hypertension from the underlying cardiac disease, along with renal failure necessitating renal replacement therapy. Twenty months after the transplant procedure, she has stable pulmonary and renal function, plus has resumed a normal daily life with improving exercise tolerance. We propose that a combined heart-lung-kidney transplantation may be an acceptable therapeutic option for carefully selected patients with advanced, concomitant cardiac, pulmonary, and kidney disease.
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- 2011
162. Case of fulminant giant-cell myocarditis associated with polymyositis, treated with a biventricular assist device and subsequent heart transplantation
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Kiran J. Philip, Lawrence S.C. Czer, Daniel Luthringer, Victor Y. Cheng, Ryan P. Morrissey, Jamal S. Rana, Ernst R. Schwarz, and Robert M. Kass
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocarditis ,Fulminant ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Ventricular tachycardia ,Polymyositis ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Heart transplantation ,business.industry ,Cardiogenic shock ,Middle Aged ,medicine.disease ,Rash ,Heart failure ,cardiovascular system ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Giant-cell myocarditis is an autoimmune myocarditis that rapidly progresses to heart failure, and is often associated ventricular tachycardia. We describe an otherwise healthy patient who was acutely ill with decompensated heart failure and ventricular tachycardia associated with rash and polymyositis, who then developed cardiogenic shock and multiorgan failure due to giant-cell myocarditis.
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- 2011
163. Prophylaxis of Cytomegalovirus Disease in Mismatched Patients after Heart Transplantation Using Combined Antiviral and Immunoglobulin Therapy
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Matthew Rafiei, M. De Robertis, A. Ruzza, A.V. Wong, Lawrence S.C. Czer, R. Vespignani, J.R. Pixton, M. Awad, and Alfredo Trento
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Graft Rejection ,medicine.medical_specialty ,medicine.medical_treatment ,Congenital cytomegalovirus infection ,Antiviral Agents ,Group A ,Gastroenterology ,Group B ,Internal medicine ,Humans ,Medicine ,Cytomegalovirus disease ,Heart transplantation ,Transplantation ,biology ,business.industry ,Histocompatibility Testing ,Immunoglobulins, Intravenous ,virus diseases ,medicine.disease ,Surgery ,Regimen ,Cytomegalovirus Infections ,biology.protein ,Heart Transplantation ,Antibody ,business - Abstract
Background. Cytomegalovirus (CMV) is a common cause of infection and morbidity after heart transplantation. Seronegative recipients (R) of seropositive donor hearts (D) are at high risk for CMV disease. We compared three different CMV prophylaxis regimens using combined antiviral and immunoglobulin therapy. Methods. In 99 patients who survived more than 30 days after heart transplant, all received induction with antilymphocytic therapy and triple-drug therapy. In group A, DR patients received one dose of intravenous immunoglobulin (IVIG) followed by one dose of CMV-specific immunoglobulin (CMV-IVIG), and intravenous ganciclovir (GCV) for 4 weeks followed by 11 months of oral acyclovir (ACV). In group B, DR patients received one dose IVIG followed by five doses of CMV-IVIG and intravenous GCV for 14 weeks followed by 9 months of oral ACV. In group C, DR patients were treated with the same regimen as for group B, except oral ACV was replaced with oral GCV. Results. The actuarial freedom from CMV disease for DR patients at 1 month, 1 year, and 2 years after transplantation in group A was 100%, 25% 15%, and 25% 15%, respectively; group B was 100%, 67% 27%, and 67% 27%; group C was 100%, 83% 15%, and 83% 15% (P .01, groups B and C vs group A). By comparison, the actuarial freedom from CMV disease for seropositive recipients (DR or DR )a t 1 month, 1 year, and 2 years in group A was 100%, 87% 7%, and 82% 8%, respectively; group B was 100%, 88% 8%, and 75% 11%; group C was 100%, 72% 9%, and 72% 9% (P NS among groups). Rejection rates did not differ among the three groups. Conclusions. A longer course of intravenous GCV with multiple doses of CMV-IVIG was a more effective prophylaxis regimen against CMV disease for the high-risk group of seronegative recipients of seropositive donor hearts.
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- 2011
164. Evaluation of the HeartMate II™ left ventricular assist device in obese heart failure patients: Effects on weight loss
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David Nguyen, Keith A. Thompson, Pavittarpaul Dhesi, Ernst R. Schwarz, J. D. Moriguchi, and Lawrence S.C. Czer
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Group comparison ,Body weight ,Weight loss ,Internal medicine ,Weight Loss ,medicine ,Humans ,Obesity ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Transplantation ,Heartmate ii ,Continuous flow ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,Ventricular assist device ,Heart failure ,Cardiology ,Female ,Heart-Assist Devices ,medicine.symptom ,business - Abstract
Summary Background: The purpose of this study is to evaluate the effect on weight loss of the newer generation continuous flow HeartMate II™ left ventricular assist device (VAD) in obese heart failure (HF) patients. Material/Methods: We retrospectively reviewed 3-year surgical data from a large heart transplant facility and identified obese patients with advanced heart failure who underwent successful implantation of either the HeartMate XVE ® or the HeartMate II ® VAD. For each patient weight and BMI at time of VAD implantation and at 6 months post-operatively were documented. Between group comparison was achieved with Student’s T tests. Results: We identified 14 patients who had received the HeartMate XVE™ and 8 who had received the HeartMate II™. At 6 months, patients who received a HeartMate XVE™ demonstrated a significant reduction in mean body weight (249.6±35.4lbs vs. 217.4±20.5 lbs; P
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- 2011
165. Dobutamine-Induced Fever and Isolated Eosinophilic Myocarditis in a 66-Year-Old Male Awaiting Heart Transplantation: A Case Report
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Lawrence S.C. Czer, C.C. Lee, and Daniel Luthringer
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Male ,Inotrope ,medicine.medical_specialty ,Cardiotonic Agents ,Myocarditis ,Fever ,Waiting Lists ,medicine.medical_treatment ,Dobutamine ,Internal medicine ,Eosinophilia ,medicine ,Humans ,Aged ,Heart Failure ,Heart transplantation ,Transplantation ,business.industry ,Dilated cardiomyopathy ,medicine.disease ,Heart failure ,Cardiology ,Heart Transplantation ,Milrinone ,Surgery ,medicine.symptom ,business ,medicine.drug - Abstract
A 66-year-old male with non-ischemic dilated cardiomyopathy who presented for decompensated heart failure and heart transplant evaluation had to be temporarily delisted from the transplant list due to fever. No infectious source was identified and drug fever was suspected. Dobutamine was discontinued and his fever subsequently defervesced. He eventually received an orthotopic heart transplantation without complication. Explanted heart showed eosinophilic myocarditis with pathologic features consistent with a drug-induced pattern of myocarditis. Throughout the hospital course, he did not develop peripheral blood eosinophilia to suggest eosinophilic myocarditis. The importance of this report is to have a greater awareness of dobutamine-induced fever and eosinophilic myocarditis even in patients without peripheral eosinophilia. In febrile patients receiving prolonged dobutamine infusion with no other evidence of infection, consideration should be given to discontinuing dobutamine or switching to an alternative inotrope such as milrinone.
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- 2014
166. Jehovah Witness Patients: Should We Liberalize Criteria for Heart Transplantation?
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R. Sharoff, N. Musto, Ryan Levine, Jon A. Kobashigawa, Michelle M. Kittleson, Jignesh Patel, Evan P. Kransdorf, Alfredo Trento, Sadia Dimbil, David Chang, and Lawrence S.C. Czer
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Witness - Published
- 2018
167. 5-Year Outcome of Renal Function with Patients on Renal-Sparing Protocol After Heart Transplantation
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Ryan Levine, David Chang, M. Johl, Lawrence S.C. Czer, N. Musto, Michelle M. Kittleson, Alfredo Trento, Jon A. Kobashigawa, Jignesh Patel, Sadia Dimbil, and M. A. Hamilton
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Protocol (science) ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Renal function ,Outcome (game theory) ,Surgery ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
168. The Risk of pAMR 1H After Heart Transplantation: Is It Bad?
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S. Sana, Michelle M. Kittleson, Sadia Dimbil, Jon A. Kobashigawa, Jignesh Patel, David Chang, Evan P. Kransdorf, M. A. Hamilton, Fardad Esmailian, Ryan Levine, Daniel Luthringer, and Lawrence S.C. Czer
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
169. Hyperlipidemia Impairs Autophagy in Chronic Heart Failure
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S. Marek-Iannucci, R.A. Gottlieb, D. Taylor, Lawrence S.C. Czer, A. Thomas, A. Andres, and K. Tucker
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Autophagy ,medicine.disease ,Heart failure ,Internal medicine ,Hyperlipidemia ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
170. Does the Type of Mechanical Circulatory Support as a Bridge to Heart Transplant Affect Outcome after Transplant?
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E. Passano, Francisco A. Arabia, G. Esmailian, J. D. Moriguchi, R. Cole, Lawrence S.C. Czer, H. Barone, Fardad Esmailian, Dael Geft, Michelle M. Kittleson, and Matthew Rafiei
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Circulatory system ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Affect (psychology) ,Outcome (game theory) ,Bridge (interpersonal) - Published
- 2018
171. Donor-derived Cell Free DNA Correlates More Closely With Intragraft mRNA Transcripts Rather Than Pathology Read Biopsies
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David Chang, Ryan Levine, Robert Woodward, Michelle M. Kittleson, Sadia Dimbil, J. Yee, Daniel Luthringer, Jon A. Kobashigawa, Lawrence S.C. Czer, Jignesh Patel, Evan P. Kransdorf, S. Sana, and P. F. Halloran
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Pulmonary and Respiratory Medicine ,Transplantation ,Messenger RNA ,business.industry ,030230 surgery ,Molecular biology ,03 medical and health sciences ,0302 clinical medicine ,Cell-free fetal DNA ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,Donor derived ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
172. In Sensitized Pre-Transplant Patients, Does IVIG after Heart Transplant Have any Benefit?
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Dael Geft, Michelle M. Kittleson, Lawrence S.C. Czer, B. Kearney, Jon A. Kobashigawa, Jignesh Patel, Evan P. Kransdorf, Sadia Dimbil, Fardad Esmailian, and Ryan Levine
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Surgery ,Transplant patient ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
173. Does a History of Malignancy Prior to Heart-transplant Increase Post-transplant Risk?
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T. Davis, Sadia Dimbil, Lawrence S.C. Czer, David Chang, Ryan Levine, A. Hsu, K. Norland, Jon A. Kobashigawa, Jignesh Patel, Evan P. Kransdorf, Michelle M. Kittleson, and Alfredo Trento
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,030232 urology & nephrology ,030230 surgery ,Malignancy ,medicine.disease ,Post transplant ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
174. Does Commuting Time to the Transplant Center Affect Compliance with Visits and Outcome after HTx in a big Metropolitan Area?
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T. Kao, Lawrence S.C. Czer, Dael Geft, Michelle M. Kittleson, David Chang, Ryan Levine, Antoine Hage, Sadia Dimbil, Angela Velleca, A. Patel, Jon A. Kobashigawa, and Jignesh Patel
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Affect (psychology) ,Metropolitan area ,Outcome (game theory) ,Compliance (psychology) ,Emergency medicine ,medicine ,Surgery ,Center (algebra and category theory) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
175. Epstein-Barr Virus Mismatch (Donor+/Recipient-): Is Cancer the Only Risk?
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Sadia Dimbil, Michelle M. Kittleson, Angela Velleca, M. A. Hamilton, Ryan Levine, Jon A. Kobashigawa, David Chang, Jignesh Patel, Lawrence S.C. Czer, Alfredo Trento, and Evan P. Kransdorf
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Pulmonary and Respiratory Medicine ,Transplantation ,business.industry ,Medicine ,Cancer ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,medicine.disease_cause ,Virology ,Epstein–Barr virus - Published
- 2018
176. Multi-Drug Resistant Infection after Heart Transplantation: How Serious is This?
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P. Zakowski, A. Shen, David Chang, R. Zabner, Ryan Levine, Sadia Dimbil, Alfredo Trento, Jon A. Kobashigawa, Jignesh Patel, Evan P. Kransdorf, Michelle M. Kittleson, and Lawrence S.C. Czer
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Multi drug resistant ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2018
177. Does ATG Induction Prevent Donor-specific Antibodies After Heart Transplantation?
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Jon A. Kobashigawa, Jignesh Patel, Evan P. Kransdorf, Antoine Hage, Sadia Dimbil, Lawrence S.C. Czer, Danny Ramzy, Michelle M. Kittleson, David Chang, K. Norland, and Ryan Levine
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,business.industry ,medicine.medical_treatment ,Donor specific antibodies ,Immunology ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
178. Novel Methods for Assessing Response to Desensitization
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Jon A. Kobashigawa, M. A. Hamilton, J. Chung, Jignesh Patel, Evan P. Kransdorf, K. Norland, David Chang, Michelle M. Kittleson, Marcelo J. Pando, Xiaohai Zhang, Sadia Dimbil, Ryan Levine, and Lawrence S.C. Czer
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Pulmonary and Respiratory Medicine ,Transplantation ,business.industry ,medicine.medical_treatment ,medicine ,Surgery ,Pharmacology ,Cardiology and Cardiovascular Medicine ,business ,Desensitization (medicine) - Published
- 2018
179. Utility of Hypercoagulable Work-Up in Predicting Post-Operative Complications in Total Artificial Heart (TAH) Implant Patients
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Jon A. Kobashigawa, D. Collier, Oksana Volod, Bernice Coleman, M. Pollack, Francisco A. Arabia, L.D. Lam, R. Lee, Lawrence S.C. Czer, J. D. Moriguchi, and D. Mochizuki
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,Work-up ,Surgery ,law.invention ,law ,Artificial heart ,medicine ,Implant ,Post operative ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
180. The Clinical Impact of Early vs Late HLA Donor-Specific Antibody Development After Heart Transplantation
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Lawrence S.C. Czer, J. Davis, Michelle M. Kittleson, Xiaohai Zhang, Alfredo Trento, David Chang, Jon A. Kobashigawa, Jignesh Patel, Evan P. Kransdorf, M. A. Hamilton, Sadia Dimbil, and Ryan Levine
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,business.industry ,Donor specific antibodies ,medicine.medical_treatment ,Immunology ,medicine ,Surgery ,Human leukocyte antigen ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
181. DOES EX VIVO PERFUSION LEAD TO MORE OR LESS INTIMAL THICKENING IN THE FIRST-YEAR POST-HEART TRANSPLANTATION?
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M. Thottam, Richard Cheng, Lawrence S.C. Czer, Babak Azarbal, Sadia Dimbil, Takuma Sato, Jon A. Kobashigawa, Ryan Levine, and Fardad Esmailian
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Heart transplantation ,medicine.medical_specialty ,Cold ischemic time ,business.industry ,medicine.medical_treatment ,Heart perfusion ,Internal medicine ,Ex vivo perfusion ,medicine ,Cardiology ,Thickening ,Cardiology and Cardiovascular Medicine ,Lead (electronics) ,business - Abstract
The Organ Care System(OCS), an ex-vivo heart perfusion system, is a physiologic alternative to cold organ storage(CS) for transport. In studies, OCS significantly shortened cold ischemic time vs CS. However, OCS requires 2 short ischemic times when the heart is placed on and off the device. It is
- Published
- 2018
182. THE USE OF CARDIAC MRI TO DETECT MYOCARDIAL FIBROSIS AND DEVELOPMENT OF RESTRICTIVE CARDIAC PHYSIOLOGY AFTER HTX
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Jon A. Kobashigawa, Michelle M. Kittleson, Jignesh Patel, Ryan Levine, Daniel S. Berman, Sadia Dimbil, Fardad Esmailian, Louise Thomson, Derek Leong, Balaji Tamarappoo, and Lawrence S.C. Czer
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Coronary artery disease ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Myocardial fibrosis ,In patient ,Small vessel ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Cardiovascular physiology - Abstract
Small vessel coronary artery disease (CAD) in patients with heart transplant is known to be associated with myocardial fibrosis (MF), which can be detected by increased T1 values on cardiac MRI; however, it is not clear whether MF detected on MRI is associated with the development of restrictive
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- 2018
183. COMBINED HEART AND KIDNEY TRANSPLANTATION: IS THERE A PROTECTIVE EFFECT AGAINST CARDIAC ALLOGRAFT VASCULOPATHY USING INTRAVASCULAR ULTRASOUND?
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Richard Cheng, Sadia Dimbil, Babak Azarbal, Jon A. Kobashigawa, Takuma Sato, Lawrence S.C. Czer, Fardad Esmailian, and Ryan Levine
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medicine.medical_specialty ,Kidney ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Cardiac allograft vasculopathy ,surgical procedures, operative ,Immune system ,medicine.anatomical_structure ,Internal medicine ,Intravascular ultrasound ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Kidney transplantation - Abstract
Combined (compared to single) organ transplants have been associated with less rejection (rejn), suggesting altered immune response to the multi-organ allograft milieu. Combined heart and kidney transplantation (HKTx) has significantly increased in recent years. It is not known if kidney Tx has a
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- 2018
184. THE CLINICAL IMPACT OF EARLY VERSUS LATE HLA DONOR-SPECIFIC ANTIBODY DEVELOPMENT AFTER HEART TRANSPLANTATION
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Jon A. Kobashigawa, Sadia Dimbil, Fardad Esmailian, Jonathan Davis, Lawrence S.C. Czer, Jignesh Patel, and Ryan Levine
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Heart transplantation ,biology ,business.industry ,medicine.medical_treatment ,Donor specific antibodies ,Human leukocyte antigen ,Cardiac allograft vasculopathy ,body regions ,Immunology ,cardiovascular system ,biology.protein ,Medicine ,Antibody ,Cardiology and Cardiovascular Medicine ,business - Abstract
Formation of donor-specific antibodies(DSA) after heart transplant(HTx) impacts short and long-term outcome including rejection (rejn), cardiac allograft vasculopathy(CAV), and survival. DSA class may be important with Class II associated with CAV. Timing of Ab development(i.e. early or late) may
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- 2018
185. Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick
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Lawrence S.C. Czer, Kiran J. Philip, Alfredo Trento, Laurent Cleenewerck, Sinan Simsir, Stuart G. Finder, and Ernst R. Schwarz
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medicine.medical_specialty ,medicine.medical_treatment ,Nursing(all) ,Heart transplantation ,Ventricular assist devices ,Quality of life (healthcare) ,Health care ,medicine ,Humans ,Health ethics ,Disease management (health) ,Intensive care medicine ,General Nursing ,Medicine(all) ,Heart Failure ,Original Paper ,business.industry ,Sick role ,Patient Selection ,Religious studies ,Sick Role ,Disease Management ,General Medicine ,medicine.disease ,Cardiopulmonary Resuscitation ,Transplantation ,Heart failure ,Candidacy ,Quality of Life ,Medical emergency ,Heart-Assist Devices ,business - Abstract
Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.
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- 2010
186. Use of Cardiac Allografts With Mild and Moderate Left Ventricular Hypertrophy Can Be Safely Used in Heart Transplantation to Expand the Donor Pool
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Robert M. Kass, Michele A. De Robertis, Alfredo Trento, James Mirocha, Robert J. Siegel, Gregory P. Fontana, Lawrence S.C. Czer, Sharo Raissi, Wen Cheng, Jason Lee, and Sorel Goland
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Adult ,Male ,medicine.medical_specialty ,Tissue and Organ Procurement ,Adolescent ,Heart Ventricles ,medicine.medical_treatment ,Left ventricular hypertrophy ,Severity of Illness Index ,Muscle hypertrophy ,Internal medicine ,Severity of illness ,medicine ,Humans ,Transplantation, Homologous ,cardiovascular diseases ,Interventricular septum ,Survival rate ,Heart transplantation ,business.industry ,Middle Aged ,medicine.disease ,Tissue Donors ,Surgery ,Survival Rate ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Circulatory system ,Cardiology ,Heart Transplantation ,Female ,Hypertrophy, Left Ventricular ,business ,Cardiology and Cardiovascular Medicine - Abstract
ObjectivesThe purpose of this study was to evaluate outcomes of heart transplantation (HTx) and changes in left ventricular wall thickness (LVWT) post-HTx using donors with left ventricular hypertrophy (LVH).BackgroundLimited data are available on use of donor hearts with LVH in HTx.MethodsWe reviewed 427 patients who underwent HTx: 62 received hearts with LVH (interventricular septum [IVS] or posterior wall [PW] thickness ≥1.2 cm) by echocardiography, and 365 received hearts without LVH. The median follow-up was 3.8 years (range 0 to 16.2 years).ResultsRecipient age was 56 ± 11 years and donor age was 30 ± 12 years. Baseline recipient characteristics were similar in both groups. Donors with LVH were older (35 ± 12 years vs. 29 ± 12 years, p = 0.001) and had higher rates of intracranial hemorrhage (38% vs. 15%, p = 0.001). The LVWT was increased in the LVH group compared with LVWT in the non-LVH group (IVS: 1.28 ± 0.18 cm vs. 0.85 ± 0.19 cm, PW: 1.27 ± 0.19 cm vs. 0.85 ± 0.20 cm, p = 0.0001 for both groups). Mild LVH (1.2 to 1.3 cm) was found in 42%, moderate (>1.3 to 1.7 cm) in 53%, and severe (>1.7 cm) in 5% of donors with LVH. Left ventricular wall thickness regression occurred in both IVS and PW (1.28 ± 0.18 cm vs. 1.10 ± 0.13 cm vs. 1.13 ± 0.14 cm, and 1.27 ± 0.19 cm vs. 1.11 ± 0.11 cm vs. 1.13 ± 0.14 cm, at baseline, 1 year, and 5 years, respectively; p < 0.001 for change from baseline to 1 and 5 years for both locations). Patients with or without donor LVH had similar 1-year (3.5% vs. 9.5%, p = 0.2) and 5-year survival rates (84 ± 5.9% vs. 70 ± 2.7%, p = 0.07).ConclusionsShort- and long-term survival rates and rates of LVH at follow-up were similar in both groups, suggesting that donor hearts with mild and moderate LVH can be safely used in HTx.
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- 2008
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187. The First Year Post–Heart Transplantation: Use of Immunosuppressive Drugs and Early Complications
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Scott D. Lick, Ernst R. Schwarz, Ramanna Merla, Nasir Z. Sulemanjee, Lawrence S.C. Czer, Serena M Aunon, Melissa Taylor, and Melissa Manson
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Graft Rejection ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Improved survival ,Comorbidity ,Hospitals, Special ,medicine ,Humans ,Pharmacology (medical) ,Intensive care medicine ,Survival analysis ,Pharmacology ,Heart transplantation ,business.industry ,medicine.disease ,Survival Analysis ,United States ,Transplantation ,Immunosuppressive drug ,Survival benefit ,Heart failure ,Heart Transplantation ,Drug Monitoring ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents - Abstract
A large number of heart transplants are performed annually in different transplant centers in the United States. This is partly because of the improved survival of patients who undergo cardiac transplantation, thus making it a more viable option in the management of end-stage heart failure. The survival benefit after heart transplantation is a result of newer immunosuppressive drug regimens and a better understanding of their effects and interactions. Several studies, mostly involving a small number of patients, describe use and comparison of the many distinct immunosuppressive drugs available to date. Interestingly, many transplant centers perform in-house typical induction treatment regimens because of their own experience and intra-institutional preference. This review summarizes current practices of immunosuppressive drug therapy in the first year post–heart transplant based on the available clinical evidence and discusses future options of heart transplant immunosuppressive drug therapies.
- Published
- 2008
188. Comparison of bypass surgery with drug‐eluting stents for diabetic patients with multivessel disease
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Alfredo Trento, James S. Forrester, Raymond Zimmer, Gilbert Chang, Gautam Kedia, Lawrence S.C. Czer, Nikhil Kapoor, Michael S. Lee, Raj Makkar, Faizi Jamal, and Michele DeRobertis
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Male ,medicine.medical_specialty ,Time Factors ,Paclitaxel ,medicine.medical_treatment ,Coronary Disease ,Coronary Angiography ,Revascularization ,Coronary artery disease ,Coronary artery bypass surgery ,Coated Materials, Biocompatible ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Coronary Artery Bypass ,Aged ,Retrospective Studies ,Sirolimus ,business.industry ,Hazard ratio ,medicine.disease ,Antineoplastic Agents, Phytogenic ,Surgery ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Bypass surgery ,Drug-eluting stent ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents ,Mace ,Follow-Up Studies - Abstract
Background This retrospective study of prospectively collected data compared coronary artery bypass graft (CABG) surgery to drug‐eluting stenting (DES) in diabetic patients with multivessel coronary artery disease (CAD). Prior randomized trials and clinical studies have suggested that CABG may be the preferred revascularization strategy in diabetic patients with multivessel CAD. Data are limited regarding the impact of DES vs. CABG on clinical outcomes. Methods We included 205 consecutive diabetic patients who underwent either CABG ( n =103) or DES ( n =102). The primary clinical end points were freedom from major adverse cardiac events (MACE) at 30 days and 1 year. Results Baseline characteristics were similar between both groups. At 1 year, the mortality rate was similar in the CABG and DES group (8% vs. 10%, p =0.6) but the MACE rate was lower in the CABG group (12% vs. 27%, p =0.006) due to less repeat revascularization with CABG (3% vs. 20%, p p =0.04). Angiographically‐documented stent thrombosis after DES occurred in 3%. Presentation with acute myocardial infarction (hazard ratio [HR], 2.26, 95% CI, 1.13 to 4.55) and DES (HR, 2.4, 95% CI, 1.23 to 4.77) were positive independent predictors, whereas therapy with a statin was a negative independent predictor of MACE (HR, 0.40, 95% CI, 0.21 to 0.76). Conclusions Bypass surgery was associated with less MACE primarily due to the higher repeat revascularization rate with DES and is therefore superior to DES despite more extensive CAD in CABG patients.
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- 2007
189. Assessment of aortic stenosis by three-dimensional echocardiography: an accurate and novel approach
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Sorel Goland, Takashi Akima, Huai Luo, Tasneem Z. Naqvi, Kiyoshi Iida, Michele A. De Robertis, Alfredo Trento, Robert J. Siegel, Kirsten Tolstrup, and Lawrence S.C. Czer
- Subjects
Adult ,Male ,Aortic valve ,Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,Transoesophageal echocardiography ,Sensitivity and Specificity ,Humans ,Medicine ,In patient ,Cardiac catheterization ,Aged, 80 and over ,Observer Variation ,Reproducibility ,business.industry ,Three dimensional echocardiography ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Aortic valve stenosis ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Rapid Communication - Abstract
Background: Accurate assessment of aortic valve area (AVA) is important for clinical decision-making in patients with aortic valve stenosis (AS). The role of three-dimensional echocardiography (3D) in the quantitative assessment of AS has not been evaluated so far. Objectives: To evaluate the reproducibility and accuracy of real-time three-dimensional echocardiography (RT3D) and 3D-guided two-dimensional planimetry (3D/2D) for assessment of AS, and compare these results with those of standard echocardiography and cardiac catheterisation (Cath). Methods: AVA was estimated by transthoracic echo-Doppler (TTE) and by direct planimetry using transoesophageal echocardiography (TEE) as well as RT3D and 3D/2D. 15 patients underwent assessment of AS by Cath. Results: 33 patients with AS were studied (20 men, mean (SD) age 70 (14) years). Bland–Altman analysis showed good agreement and small absolute differences in AVA between all planimetric methods (RT3D vs 3D/2D: −0.01 (0.15) cm 2 ; 3D/2D vs TEE: 0.05 (0.22) cm 2 ; RT3D vs TEE: 0.06 (0.26) cm 2 ). The agreement between AVA assessment by 2D–TTE and planimetry was −0.01 (0.20) cm 2 for 3D/2D; 0.00 (0.15) cm 2 for RT3D; and −0.05 (0.30) cm 2 for TEE. Correlation coefficient r for AVA assessment between each of 3D/2D, RT3D, TEE planimetry and Cath was 0.81, 0.86 and 0.71, respectively. The intraobserver variability was similar for all methods, but interobserver variability was better for 3D techniques than for TEE (p Conclusions: The 3D echo methods for planimetry of the AVA showed good agreement with the standard TEE technique and flow-derived methods. Compared with AV planimetry by TEE, both 3D methods were at least as good as TEE and had better reproducibility. 3D aortic valve planimetry is a novel non-invasive technique, which provides an accurate and reliable quantitative assessment of AS.
- Published
- 2007
190. Risk Factors Associated With Reoperation and Mortality in 252 Patients After Aortic Valve Replacement for Congenitally Bicuspid Aortic Valve Disease
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Gregory P. Fontana, Wen Chang, Lawrence S.C. Czer, Sorel Goland, James Mirocha, Michele A. De Robertis, Alfredo Trento, and Robert M. Kass
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Heart Defects, Congenital ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Aortic Diseases ,Cohort Studies ,Coronary artery disease ,Bicuspid aortic valve ,Aortic valve replacement ,Risk Factors ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Heart valve ,Cardiac Surgical Procedures ,Aorta ,Aged ,Retrospective Studies ,Ejection fraction ,business.industry ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Dilatation, Pathologic ,Follow-Up Studies - Abstract
We aimed to determine the risk factors associated with mortality in patients with congenitally bicuspid aortic valve disease and dilation (5 cm) of the ascending aorta after aortic valve replacement.We reviewed 252 patients with bicuspid aortic valve undergoing aortic valve replacement at our institution from 1971 through 2000. Patients undergoing concomitant replacement of the ascending aorta were excluded.The average patient age was 61 +/- 15 years; 66.3% were male, and 40.5% of patients had coronary artery disease. The ascending aorta was normal (4.0 cm) in 60.3%, mildly dilated (4.0 to 4.4 cm) in 24.2%, and moderately dilated (4.5 to 4.9 cm) in 15.5% of patients. Patients with moderate aortic dilatation had significantly lower prevalence of coronary artery disease compared with patients with normal ascending aortas (20.5% and 45.4%; p = 0.006). Mean follow-up was 8.9 +/- 6.3 years. Long-term survival was significantly different across the three groups (p = 0.004). The 5-, 10-, and 15-year estimates were 78%, 59%, and 37%, respectively, in the normal aorta group; 88%, 77%, and 46%, respectively, in the mild aortic dilation group; and 92%, 83%, and 70%, respectively, in the moderate aortic dilation group. No significant difference in cardiac death was found among the groups (p = 0.08). The significant predictors of survival using the Cox regression model were coronary artery disease, age, decade of surgery, and ejection fraction. Aortic dilation was not significant after adjusting for these other variables. At follow-up, 18 patients required reoperation, 17 for aortic valve prosthesis failure and 1 for ascending aorta aneurysm.The present study highlights the important adverse effect of concomitant coronary artery disease, advanced age, earlier decade of surgery, and reduced left ventricular ejection fraction on survival after aortic valve replacement for bicuspid aortic valve in patients with no or mild and moderate (5 cm) dilation of the ascending aorta.
- Published
- 2007
191. THE USE OF VITAMIN C AND E AFTER HEART TRANSPLANT REVISITED
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Jon A. Kobashigawa, Minh B. Luu, David Chang, Michelle M. Kittleson, Fardad Esmailian, Frank Liou, Esha Sachdev, Lawrence S.C. Czer, and Jignesh Patel
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medicine.medical_specialty ,Vitamin C ,business.industry ,Internal medicine ,Long term survival ,cardiovascular system ,Medicine ,Transplant patient ,Limiting ,business ,Cardiac allograft vasculopathy ,Cardiology and Cardiovascular Medicine ,Gastroenterology - Abstract
Cardiac allograft vasculopathy (CAV) is one of the main limiting factors in long term survival in heart transplant patients. Vitamin C and E (vit C & E) are potent antioxidants which may have a role in slowing CAV progression. Fang et al reported previously (Lancet. 2002: 359: 1108-1113) that vit C
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- 2015
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192. Comparison of Coronary Artery Bypass Surgery With Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease
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Joseph Aragon, Alfredo Trento, Prediman K. Shah, James S. Forrester, Suhail Dohad, Faizi Jamal, Michael S. Lee, Lawrence S.C. Czer, Neal L. Eigler, Nikhil Kapoor, Saibal Kar, Robert M. Kass, and Raj Makkar
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Disease ,Revascularization ,Coronary artery bypass surgery ,Left coronary artery ,Internal medicine ,Angioplasty ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Aged ,Proportional Hazards Models ,business.industry ,Percutaneous coronary intervention ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,surgical procedures, operative ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,Stents ,business ,Cardiology and Cardiovascular Medicine ,Artery - Abstract
ObjectivesThis study evaluated the clinical outcomes of consecutive, selected patients treated with coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (ULMCA) disease.BackgroundAlthough recent data suggest that PCI with DES provides better clinical outcomes compared to bare-metal stenting for ULMCA disease, there is a paucity of data comparing PCI with DES to CABG.MethodsSince April 2003, when DES first became available at our institution, 123 patients underwent CABG, and 50 patients underwent PCI with DES for ULMCA disease.ResultsHigh-risk patients (Parsonnet score >15) comprised 46% of the CABG group and 64% of the PCI group (p = 0.04). The 30-day major adverse cardiac and cerebrovascular event (MACCE) rate for CABG and PCI was 17% and 2% (p < 0.01), respectively. The mean follow-up was 6.7 ± 6.2 months in the CABG group and 5.6 ± 3.9 months in the PCI group (p = 0.26). The estimated MACCE-free survival at six months and one year was 83% and 75% in the CABG group versus 89% and 83% in the PCI group (p = 0.20). By multivariable Cox regression, Parsonnet score, diabetes, and CABG were independent predictors of MACCE.ConclusionsDespite a higher percentage of high-risk patients, PCI with DES for ULMCA disease was not associated with an increase in immediate or medium-term complications compared with CABG. Our data suggest that a randomized comparison between the two revascularization strategies for ULMCA may be warranted.
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- 2006
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193. Letter by Makkar et al Regarding Article, 'Cell Therapy for Heart Failure: A Comprehensive Overview of Experimental and Clinical Studies, Current Challenges, and Future Directions'
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Gary Gerstenblith, Stuart D. Russell, Eduardo Marbán, Lawrence S.C. Czer, Rachel Ruckdeschel Smith, and Raj Makkar
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Pathology ,medicine.medical_specialty ,Heart disease ,Physiology ,business.industry ,Human heart ,medicine.disease ,Endomyocardial biopsy ,Cell therapy ,Heart failure ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
In their review of cell therapy for heart disease, Sanganalmath and Bolli1 conclude their discussion on the CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction (CADUCEUS) trial2,3 by stating “However, the amount of tissue used to produce CDCs was reported to be 276 mg [SD, 177; range, 93–891 mg] which is all but impossible to obtain with endomyocardial biopsies.” We disagree with this conclusion. In CADUCEUS, we reported something that had never been done before: the harvesting of human heart tissue, using a catheter, to create a therapeutic product. Thus, there is little basis for direct comparison in the literature. Endomyocardial biopsy specimens obtained for routine diagnostic purposes are not weighed (they are fixed and processed …
- Published
- 2014
194. Ischemic Mitral Regurgitation: Revascularization Alone Versus Revascularization and Mitral Valve Repair
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Carlos Blanche, Kathy E. Magliato, Alfredo Trento, Sharo Raissi, Michele A. De Robertis, Harmik J. Soukiasian, Robert M. Kass, Lawrence S.C. Czer, James Mirocha, Yong-Hwan Kim, and Robert J. Siegel
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Myocardial Ischemia ,Ischemia ,Revascularization ,Severity of Illness Index ,Internal medicine ,Mitral valve ,Myocardial Revascularization ,medicine ,Humans ,Myocardial infarction ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,Mitral regurgitation ,Ejection fraction ,business.industry ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Survival Analysis ,Echocardiography, Doppler ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Cardiology ,Myocardial infarction complications ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
In this study we compared the surgical management of ischemic mitral regurgitation (IMR) by revascularization alone and by revascularization combined with mitral valve repair.We studied 355 patients who underwent revascularization alone (n = 168) or revascularization combined with mitral valve repair (n = 187) for IMR from March 1994 to September 2003. Preoperative and operative characteristics, postoperative mitral regurgitation severity, operative mortality, and late survival were examined for each surgical group.No differences were noted between the two groups in age, sex, history of diabetes or hypertension, and number of bypass grafts. The combined surgical group had a lower preoperative left ventricular ejection fraction (0.38 +/- 0.14 versus 0.44 +/- 0.15), greater severity of IMR, higher frequency of prior myocardial infarction, and longer cross-clamp and pump times (p0.01). The combined surgical group had a greater reduction in IMR grade (2.7 +/- 0.1 grades versus 0.2 +/- 0.1 grade), a lower postoperative IMR grade (0.9 +/- 0.1 versus 2.3 +/- 0.1), and a higher success with reduction of IMR by two or more grades (89% versus 11%) (p0.001). In patients with 3+ or 4+ IMR, both groups had similar operative mortality (11.0% in the combined group compared with 4.7% for revascularization alone, p = 0.11) and actuarial survival at 5 years (44% +/- 5% versus 41% +/- 7%, p = 0.53). Independently predictive of higher early mortality (or = 30 days) by Cox analysis were longer pump time (p0.001) and older age (p0.02). Predictive of late mortality (30 days) were older age (p0.001), fewer bypass grafts (p0.01), and lower ejection fraction (p0.01). After adjustment for these variables, there was a trend (p = 0.08) toward a higher late survival with the combined surgical procedure.In patients with IMR, combined mitral valve repair and revascularization resulted in less postoperative mitral regurgitation and similar 5-year survival when compared with revascularization alone. Attempts to reduce pump time by using off-pump techniques may reduce early mortality in these high-risk patients.
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- 2005
195. Heart Transplantation for End-Stage Heart Failure Due to Cardiac Sarcoidosis
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A. Ruzza, Mark M. Awad, Jignesh Patel, Matthew Rafiei, Ryan P. Morrissey, Jon A. Kobashigawa, D.P. Perkel, and Lawrence S.C. Czer
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Heart transplantation ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Immunosuppression ,Retrospective cohort study ,Cardiac sarcoidosis ,medicine.disease ,Surgery ,Pneumonia ,Internal medicine ,Heart failure ,cardiovascular system ,medicine ,Cardiology ,Sarcoidosis ,business - Abstract
Background Cardiac sarcoidosis with end-stage heart failure has a poor prognosis without transplantation. The rates of sarcoid recurrence and rejection are not well established after heart transplantation. Methods A total of 19 heart transplant recipients with sarcoid of the explanted heart were compared with a contemporaneous control group of 1,050 heart transplant recipients without cardiac sarcoidosis. Assessed outcomes included 1st-year freedom from any treated rejection, 5-year actuarial survival, 5-year freedom from cardiac allograft vasculopathy (CAV), 5-year freedom from nonfatal major adverse cardiac events (NF-MACE), and recurrence of sarcoid in the allograft or other organs. Patients with sarcoidosis were maintained on low-dose corticosteroids after transplantation. Results There were no significant differences between the sarcoid and control groups in 1st-year freedom from any treated rejection (79% and 90%), 5-year posttransplantation survival (79% and 83%), 5-year freedom from CAV (68% and 78%), and 5-year freedom from NF-MACE (90% and 88%). Causes of death (n = 5) in the sarcoid group were coccidioidomycosis, pneumonia, rejection, hemorrhage, and CAV. No patient had recurrence of sarcoidosis in the cardiac allograft. Three of 19 patients (16%) experienced recurrence of extracardiac sarcoid, with no mortality. Conclusions Patients with cardiac sarcoidosis undergoing heart transplantation have acceptable long-term outcomes without evidence of recurrence of sarcoidosis in the allograft when maintained on low-dose corticosteroids. Progression of extracardiac sarcoid was uncommon, possibly related to immunosuppression. In patients with cardiac sarcoidosis, heart transplantation is a viable treatment modality.
- Published
- 2013
196. Combined heart and kidney transplantation: what is the appropriate surgical sequence?
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Lawrence S.C. Czer, Fardad Esmailian, Alfredo Trento, and A. Ruzza
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Graft Rejection ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Brief Communication ,Preoperative care ,Kidney transplant ,Risk Factors ,medicine ,Humans ,Survival rate ,Kidney transplantation ,Aged ,Retrospective Studies ,Heart transplantation ,business.industry ,Graft Survival ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Los Angeles ,Histocompatibility ,Surgery ,Transplantation ,Treatment Outcome ,surgical procedures, operative ,Practice Guidelines as Topic ,Heart Transplantation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents - Abstract
Combined heart and kidney transplantation is increasing in frequency but there are no guidelines to establish the indications, contraindications and sequence for this surgical procedure. We report our single-centre experience on 30 consecutive patients who underwent combined heart and kidney transplant in comparison with heart transplant alone. Patients had similar preoperative characteristics in both groups. Combined heart and kidney transplant is associated with the same long-term survival rate, low cellular rejection and antibody-mediated rejection rates when compared with heart transplant alone. We did not observe any difference in the outcomes related to preoperative patient characteristics. We suggest the staged surgical approach as the preferred method for transplant.
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- 2013
197. Eosinophilic myocarditis in patients awaiting heart transplantation*
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Carmen A. Queral, James Mirocha, Lawrence S.C. Czer, Adrian W. Quartel, Michael C. Fishbein, Daniel Luthringer, Johanna J.M. Takkenberg, Carlos Blanche, and Alfredo Trento
- Subjects
Male ,medicine.medical_specialty ,Cardiotonic Agents ,Myocarditis ,Heart disease ,Dopamine ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,Critical Care and Intensive Care Medicine ,Statistics, Nonparametric ,Drug Hypersensitivity ,Pharmacotherapy ,Dobutamine ,Intensive care ,Eosinophilia ,Eosinophilic ,medicine ,Humans ,Diuretics ,Survival rate ,Heart transplantation ,business.industry ,Middle Aged ,medicine.disease ,United States ,Surgery ,Survival Rate ,Heart Transplantation ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
To determine the possible causative agents of eosinophilic or hypersensitivity myocarditis in patients awaiting heart transplantation.Consecutive patient series.Large university-affiliated hospital.A total of 190 consecutive patients who had heart transplantation at our center.The myocardium of the explanted heart was examined for a mixed inflammatory cell infiltrate containing an identifiable component of eosinophils. The relative quantity of each cell type was evaluated by a semiquantitative grading system (scored 0 to 3). The clinical findings and medications were reviewed, and patients were followed after heart transplantation.Eosinophilic myocarditis (EM) was found in the explanted heart in 14 patients (7.4%). Myocardial infiltration by eosinophils ranged from mild (n = 6), often focal involvement to marked (n = 8), usually multifocal or widespread involvement. Twelve patients (86%) had peripheral blood eosinophilia before transplant, and in ten (71%), the eosinophil count at least doubled. Loop or thiazide diuretics were used in all 14 patients, and angiotensin-converting enzyme inhibitors were used in 12. Preoperative characteristics were similar in patients with and without EM, except for a higher frequency of inotropic support and assist devices in EM patients. Dobutamine was used in 12 (86%) and dopamine in seven (50%; one with dopamine alone), and one patient (7%) received neither dopamine nor dobutamine. In two patients receiving dobutamine and one receiving dopamine, tapering or discontinuation of the inotropic infusion resulted in a significant diminution of the peripheral eosinophilia and the EM before transplantation. Postoperative survival in patients with and without EM was similar at 8 yrs (50% +/- 13% and 54% +/- 4%, p =.34). No patient in this study has had EM on biopsy after transplant.EM is a complication of multiple drug therapy in patients awaiting heart transplantation, and should be suspected when peripheral blood eosinophilia is present or the eosinophil count increases by at least two-fold. EM may be related to intravenous inotropic therapy, and this is the first study to document improvement in myocardial pathology after inotropic drug withdrawal. Hypersensitivity to thiazide and loop diuretics, angiotensin-converting enzyme inhibitors, and antibiotics must also be considered. Survival after heart transplantation is not impaired, and postoperative steroid therapy may prevent EM.
- Published
- 2004
198. Making an Impossible Mission Possible
- Author
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Sergio L. Kobal, Robert B. Hamilton, Peter Czer, Zhanna Feldsher, Robert J. Siegel, and Lawrence S.C. Czer
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Medical missions ,Population ,Disease ,Critical Care and Intensive Care Medicine ,Left ventricular hypertrophy ,Ghana ,Limited access ,Diagnostic equipment ,medicine ,Humans ,Mass Screening ,cardiovascular diseases ,Child ,education ,Intensive care medicine ,Mass screening ,Aged ,education.field_of_study ,business.industry ,Infant ,Medical Missions ,Middle Aged ,medicine.disease ,Surgery ,Echocardiography ,Child, Preschool ,Hypertension ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Limited resources - Abstract
Cardiovascular disease (CVD) is widespread in developing countries. Hypertension is a major contributor of CVD. Left ventricular hypertrophy (LVH) is a risk marker in hypertensive populations. Identification of LVH and treatment of high-risk patients can result in more effective use of the limited resources. LVH is diagnosed by echocardiography, often unavailable in developing countries. In Gambia, we used a hand-carried ultrasound (HCU) to examine 1,997 people. Seventeen percent had hypertension; of these, LVH was found in 65%. The battery-powered HCU permits clinicians to detect LVH in areas with limited access to diagnostic equipment, allowing identification of a high-risk hypertensive population.
- Published
- 2004
199. When a Prospective Crossmatch Is Warranted in the Virtual Crossmatch (VXM) Era
- Author
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Danny Ramzy, M. Yang, S. Sana, Nancy L. Reinsmoen, J. Rush, Lawrence S.C. Czer, Jignesh Patel, Jon A. Kobashigawa, Dael Geft, E. Stimpson, Michelle M. Kittleson, and Tamar Aintablian
- Subjects
Pulmonary and Respiratory Medicine ,03 medical and health sciences ,Transplantation ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,030230 surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2016
200. MCS Driveline Infections: Are They Truly Risk Factors for Poor Outcome?
- Author
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J. D. Moriguchi, R. Jocson, H. Henry, Tamar Aintablian, David Chang, Dael Geft, C. Runyan, Francisco A. Arabia, Lawrence S.C. Czer, and E. Passano
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Outcome (game theory) - Published
- 2016
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